A massive earthquake hit Nepal in April followed by a strong
aftershock in May. The earthquake had an impact in 31
districts out of the 75 districts of the country and total death
toll reached 9,000, injured 23,000 and damaged 900,000
houses[1]. Recent global and regional publications have
indicated growing public health concerns and rebuilding
infrastructures following the earthquake [2,3,4]; however none
of the articles have focused on reproductive health care
services, particularly on birthing centres in Nepal.
Although Nepal has made substantial progress in reducing
maternal mortality (from 364 per 100,000 live birth in 1996 to
170 per 100,000 live birth in 2010), there are concerns for the
sustainability of maternal and child health care following the
earthquakes[5]. A total of 1.4 million women and girls of
reproductive age were affected in the 14 severely affected
districts in the country. There were an estimated 93,000
pregnant women during an earthquake, up to 10,000 delivering
each month and 1,000 to 1,500 at risk of pregnancy-related
complications requiring emergency obstetric care[6]. The
earthquake destroyed nearly 84% (375 / 446) of health
facilities in the earthquake affected districts [6] (most offering
birthing facilities) which could further worsen the already low
health-facility delivery rate (35%) and low delivery by skilled
birth attendants (36%)[7]. Around 70% to 90% of birthing
centres across the 14 most affected districts are destroyed or
damaged with number of mothers giving birth outside
hospitals and birthing centres to have reached more than a
third in these most affected areas[8].
The damage to primary health care facilities and birthing
centres in rural areas of the earthquake-affected area is a major
concern, as these facilities act as a first contact point for the
women seeking maternity services. Damage to these facilities,
however, hinders the provision of basic obstetric care, thus
putting the lives of childbearing women at risk. In this moment
of crisis, Nepal should reinstate its network of mobile outreach
clinics providing maternity care services by skilled birth
attendants while re-building birthing centres takes place[5].
Other possible interventions could also be helpful like training
skilled birth attendants and improving community based health
services along with building temporary birthing tents[9].